Antipsychotic Medications and Risk Profiles Associated with Pneumonia in Patients with Schizophrenia Receiving Home-Care Case Management Intervention in Taiwan
C.-J. Kuo1, Y.-T. Liu1, W.-Y. Chen2, C.-C. Chen3
1Taipei City Psychiatric Center, Department of General Psychiatry, Taipei, Taiwan, 2Taipei City Psychiatric Center, Department of Community Psychiatry, Taipei, Taiwan, 3Mackay Memorial Hospital, Department of Psychiatry, Taipei, Taiwan
Background: Home-care case management (CM) is a community outreach service, though research on the incidences of infectious diseases in patients receiving home-care CM remains limited.
Aims & Objectives: This study aimed to investigate the incidence of various infectious diseases and identify risk factors for pneumonia in schizophrenia patients receiving home-care CM.
Method: Data from Taiwan's National Health Insurance Research Database (January 1, 2000, to December 31, 2019) were used to form a cohort of schizophrenia patients receiving home-care CM (n = 19,687). Pneumonia was the most frequently occurring infectious disease during follow-up (n = 3966). A nested case–control study was conducted to determine pneumonia risk factors. Risk set sampling was used to randomly select controls for each pneumonia case, and conditional logistic regression was applied for statistical analysis.
Results: Pneumonia had the highest standardized incidence ratio among the infectious diseases in the cohort. Of the 3966 pneumonia cases, 56.9% were men. After matching, 3961 case–control pairs were created. Psychiatric comorbidities, particularly dementia and depressive disorders, were linked to a higher risk of pneumonia (adjusted incidence rate ratios [aIRRs]: 2.73 and 1.34, respectively). Unlike oral antipsychotics, long-acting injectables were not associated with increased pneumonia risk, suggesting they could be a safer treatment choice for schizophrenia patients.
Discussion & Conclusions: The study highlights an increased risk of pneumonia in schizophrenia patients receiving home-care CM, which is further exacerbated by various physical and psychiatric comorbidities. Clinical teams often opt for long-acting injectable antipsychotics due to prior nonadherence, and this study supports their use, indicating they may be a safer option. These findings advocate for comprehensive care strategies to mitigate pneumonia risk in this vulnerable population.
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